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DISCIPLINARY ORDERS POSTED for 2015

TEXAS DEPARTMENT OF INSURANCE

Division of Workers' Compensation

A Commissioner of Workers’ Compensation consent order (settlement) imposing sanctions becomes final upon signature of the Commissioner of Workers’ Compensation. System participants are entitled to a hearing at the State Office of Administrative Hearings (SOAH) if they do not wish to settle the enforcement matter. If there is a hearing on an enforcement matter at SOAH, the SOAH Administrative Law Judge will issue a Proposal for Decision (PFD). The Commissioner of Workers’ Compensation will then consider the case, and shall issue a decision or order that may become final. The decision or order that may become final will become final in accordance with Government Code chapter 2001, subchapters F and G.

Copies of Commissioner of Insurance and or Commissioner of Workers' Compensation orders may be obtained only by an open records request. Your request can be sent by email, fax, mail, or in person. Learn more about how to request information.


Summaries of the orders follow.

Ace American Insurance Company of Wilmington, DE
Order Number: DWC-4206
Date of Order:  12/2/2015
Action Taken:  Fined $15,000
Violation:  Failed to timely pay income benefits to injured employees; failed to timely comply with a TDI-DWC order


Buchanan, Lynn, D.O. of Del Rio
Order Number: DWC-4211
Date of Order:  12/4/2015
Action Taken:  Fined $4,000
Violation:  Failed to comply with order of TDI-DWC


Commerce and Industry Insurance Company of New York, NY
Order Number: DWC-4235
Date of Order:  12/28/2015
Action Taken:  Fined $15,000
Violation:  Failed to timely pay income benefits to injured employees


Dallas I.S.D. of Dallas
Order Number: DWC-4212
Date of Order:  12/4/2015
Action Taken:  Fined $2,000
Violation:  Failed to timely pay income benefits to injured employee


Halaby, Gerald A., M.D. of Cypress
Order Number: DWC-4218
Date of Order:  12/11/2015
Action Taken:  Fined $500
Violation:  Failed to comply with commissioner's order to complete continuing education requirement.


Indemnity Insurance Company of North America of Philadelphia, PA
Order Number: DWC-4232
Date of Order:  12/28/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employee; failed to timely pay attorney's fees


Kjeldgaard, Larry Mitchell D.O. of Hurst
Order Number: DWC-4205
Date of Order:  12/2/2015
Action Taken:  Medical practice in Texas workers' compensation system subject to review by TDI-DWC under a limited monitoring plan
Violation:  Improperly administered treatments or services


Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-4204
Date of Order:  12/1/2015
Action Taken:  Fined $35,000
Violation:  Failed to timely report termination of death benefits to TDI-DWC; failed to accurately pay death benefits to injured employee's beneficiaries


New Hampshire Insurance Company of New York, NY
Order Number: DWC-4234
Date of Order:  12/28/2015
Action Taken:  Fined $4,000
Violation:  Failed to submit complete documentation of employee injuries determined to by compensable to TDI-DWC


Northeast Baptist Hospital of San Antonio
Order Number: DWC-4207
Date of Order:  12/2/2015
Action Taken:  Fined $2,000
Violation:  Improperly billed injured employee for workers' compensation medical services provided.


Praetorian Insurance Company of New York, NY
Order Number: DWC-4231
Date of Order:  12/28/2015
Action Taken:  Fined $20,000
Violation:  Failed to timely process medical bills; failed to accurately submit medical electronic data interchange records to TDI-DWC


Soberanis, Jose D.C. of Irving
Order Number: DWC-4216
Date of Order:  12/8/2015
Action Taken:  Fined $10,000; must not apply to designated doctor list or for maximum medical improvement/impairment rating certification for 10 years
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Starr Indemnity & Liability Company of New York, NY
Order Number: DWC-4236
Date of Order:  12/28/2016
Action Taken:  Fined $500
Violation:  Failed to timely pay income benefits to injured employees


Starr Indemnity and Liability Company of New York, NY
Order Number: DWC-4208
Date of Order:  12/2/2015
Action Taken:  Fined $5,500
Violation:  Failed to timely pay accrued and unpaid income benefits to injured employee as ordered by TDI-DWC


White, Stephen C., M.D. of Durant, OK
Order Number: DWC-4233
Date of Order:  12/28/2015
Action Taken:  Must complete medical record documentation training
Violation:  Failed to document consultation with injured employee including employee's refusal of health care within appropriate time frame


Bradley, David D.C. of North Richland Hills
Order Number: DWC-4185
Date of Order:  11/17/2015
Action Taken:  Fined $1,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records; failed to sufficiently respond to a letter of clarification ordered by division


Old Republic Insurance Company of Greensburg, PA
Order Number: DWC-4189
Date of Order:  11/17/2015
Action Taken:  Fined $4,000
Violation:  Failed to timely pay income benefits to injured employees


Rapid Tox Screen, L.L.C. of Plano
Order Number: DWC-4188
Date of Order:  11/17/2015
Action Taken:  Fined $4,000
Violation:  Failed to respond to request for refund from insurance carrier; failed to comply with division order


T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-4186
Date of Order:  11/17/2015
Action Taken:  Fined $11,500
Violation:  Failed to process claims in reasonable and prudent manner; failed to timely contact and offer a survey to its policyholder after learning of a work-related fatality


T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-4187
Date of Order:  11/17/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely comply with decision of commissioner


TASB Risk Management, Inc. of Austin
Order Number: DWC-4184
Date of Order:  11/17/2015
Action Taken:  Fined $25,000
Violation:  Failed to timely pay income benefits to injured employees


Worrell, John Mays, Jr., M.D. of Midland
Order Number: DWC-4192
Date of Order:  11/18/2015
Action Taken:  Must complete continuing medical education
Violation:  Administered improper, unreasonable or medically unnecessary treatment


ACS Primary Care Physicians Southwest PA of Cincinnati, OH
Order Number: DWC-4146
Date of Order:  10/9/2015
Action Taken:  Fined $3,000
Violation:  Improperly billed an injured employee for workers' compensation medical services provided.


American Guarantee and Liability Insurance Company of Schaumburg, IL
Order Number: DWC-4147
Date of Order:  10/9/2015
Action Taken:  Fined $6,000
Violation:  Failed to accurately pay lifetime income benefits to injured employees on two claims


City of Houston of Houston
Order Number: DWC-4164
Date of Order:  10/28/2015
Action Taken:  Fined $2,000
Violation:  Failed to timely pay attorney fees


Coolbaugh, Robert J., D.C. of Lubbock
Order Number: DWC-4141
Date of Order:  10/7/2015
Action Taken:  (SOAH DOCKET NO. 454-14-3930.C1) Fined $10,000
Violation:  Failed to timely comply with division orders


Hood, James Furniss M.D. of Houston
Order Number: DWC-4145
Date of Order:  10/9/2015
Action Taken:  Must complete designated doctor training
Violation:  Failed to properly determine and report maximum medical improvement certification date and to appropriately report and accurately assign a whole body impairment rating for injured employee


Markel Insurance Company of Glen Allen, VA
Order Number: DWC-4165
Date of Order:  10/28/2015
Action Taken:  Fined $10,000
Violation:  Failed to timely act on a properly completed medical bill; failed to submit accurate medical EDI records to the Division


National Interstate Insurance Company of Richfield, OH
Order Number: DWC-4148
Date of Order:  10/9/2015
Action Taken:  Fined $15,000
Violation:  Failed to accurately pay death benefits; failed to provide accurate claim data to Division


New Hampshire Insurance Company of New York, NY
Order Number: DWC-4134
Date of Order:  10/2/2015
Action Taken:  Fined $7,000
Violation:  Failed to timely pay income benefits to injured employee


New Hampshire Insurance Company of New York, NY
Order Number: DWC-4137
Date of Order:  10/5/2015
Action Taken:  Fined $8,500
Violation:  Failed to comply with order to timely pay income benefits to injured employee; failed to timely pay attorney's fees; failed to timely act on a properly completed medical bill


Obasi, Patrick Chidi, M.D. of Marshall
Order Number: DWC-4167
Date of Order:  10/28/2015
Action Taken:  Fined $2,000; must not re-apply for designated doctor or maximum medical improvement/impairment rating certification for two years.
Violation:  Deficiencies in examinations of injured employees as part of a medical quality review


Pulido, Christopher, D.C. of Pearland
Order Number: DWC-4144
Date of Order:  10/9/2015
Action Taken:  Fined $2,000
Violation:  Failed to obtain injured employee's agreement before rescheduling a designated doctor examination appointment


Setliff, Michael, D.C. of Laredo
Order Number: DWC-4135
Date of Order:  10/2/2015
Action Taken:  Fined $500; Must complete designated doctor training
Violation:  Failed to adequately complete designated doctor narrative report


Shade, Ronnie D., M.D. of Fort Worth
Order Number: DWC-4170
Date of Order:  10/28/2015
Action Taken:  Fined $500
Violation:  Failed to comply with Division order


Technology Insurance Company, Inc. of New York, NY
Order Number: DWC-4166
Date of Order:  10/28/2015
Action Taken:  Fined $1,500
Violation:  Failed to comply with order to timely pay attorney's fees


Twin City Fire Insurance Company of Hartford, CT
Order Number: DWC-4169
Date of Order:  10/28/2015
Action Taken:  Fined $5,500
Violation:  Failed to timely pay income benefits to injured employee; failed to pay income benefits during the pendency of a dispute


Weigel, Sofia Maristany, M.D. of Dallas
Order Number: DWC-4160
Date of Order:  10/21/2015
Action Taken:  Fined $25,000
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


American Zurich Insurance Company of Schaumburg, IL
Order Number: DWC-4122
Date of Order:  9/22/2015
Action Taken:  Fined $7,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely contact and offer a survey to its policyholder after a work-related fatality


Arch Insurance Company of Jersey City, NJ
Order Number: DWC-4132
Date of Order:  9/25/2015
Action Taken:  Fined $1,200
Violation:  Failed to comply with an order to pay attorney's fees; failed to timely pay attorney's fees


Armstrong, Jarrett H., D.C. of Keller
Order Number: DWC-4116
Date of Order:  9/18/2015
Action Taken:  Fined $500
Violation:  Failed to timely notify TDI-DWC that he had not received medical records; failed to reschedule designated doctor examination


Capitol Emergency Associates, P.A. of Oklahoma City, OK
Order Number: DWC-4121
Date of Order:  9/22/2015
Action Taken:  Fined $4,500
Violation:  Improperly billed an injured employee for workers' compensation medical services provided


City of El Paso of El Paso
Order Number: DWC-4114
Date of Order:  9/16/2015
Action Taken:  Fined $21,000
Violation:  Failed to pay accurate death benefits


Hernandez, Arthur S., M.D. of San Antonio
Order Number: DWC-4113
Date of Order:  9/16/2015
Action Taken:  Fined $5,000; will not provide health care to injured employees in the Texas workers' compensation system or receive any renumeration from the Texas workers’ compensation system
Violation:  Ordered treatment and/or diagnostic testing of an injured employee without documenting justification for the testing


Loper, David W., D.C. of Georgetown
Order Number: DWC-4099
Date of Order:  9/1/2015
Action Taken:  Fined $1,000.
Violation:  Failed to timely file and/or accurately complete TDI-DWC forms, reports or records


Miller, Hank K., D.C. of Midlothian
Order Number: DWC-4106
Date of Order:  9/10/2015
Action Taken:  Fined $5,000; must not re-apply for designated doctor certification or maximum medical improvement/impairment rating credentials.
Violation:  Improperly certified maximum medical improvement of an injured employee without performing complete medical examination; failed to file work status report for an injured employee; ordered unnecessary testing and failed to explain rationale for testing during designated doctor examination


Northern Insurance Company of New York of Schaumburg, IL
Order Number: DWC-4111
Date of Order:  9/15/2015
Action Taken:  Fined $2,000
Violation:  Failed to pay accurate lifetime income benefits to an injured employee


Safety National Casualty Corporation of St. Louis, MO
Order Number: DWC-4123
Date of Order:  9/22/2015
Action Taken:  Fined $1,000
Violation:  Failed to comply with an order to pay attorney's fees; failed timely pay attorney's fees


Travelers Indemnity Company of Hartford, CT
Order Number: DWC-4115
Date of Order:  9/16/2015
Action Taken:  Fined $3,000
Violation:  Failed to timely act on a properly completed medical bill


Travelers Indemnity Company of Connecticut of Austin
Order Number: DWC-4105
Date of Order:  9/10/2015
Action Taken:  Fined $60,000
Violation:  Failed to pay accurate death benefits to legal beneficiaries; failed to timely report termination of death benefits to TDI-DWC


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